Pimobendan did not significantly improve 6-minute walking distance compared to placebo in patients with heart failure with preserved ejection fraction and right ventricular-pulmonary arterial uncoupling (MD 5.5 m, p=0.402).
RCT (n=50)
Double-blind
1:1
Yes
Does pimobendan improve exercise capacity in hospitalized patients with HFpEF and RV-PA uncoupling?
In patients with HFpEF and RV-PA uncoupling, 30 days of pimobendan therapy did not significantly improve exercise capacity compared to placebo.
Mean Difference: 5.5 (95% CI -38.9–49.8)
Absolute Event Rate: 26.9% vs 21.4%
p-value: p=0.402
Background: Patients with heart failure with preserved ejection fraction (HFpEF) and right ventricular (RV)–pulmonary arterial (PA) uncoupling, as assessed by a decrease ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) on echocardiography, have poorer outcomes than patients without RV-PA uncoupling. Methods and Results: The MONACO trial was an adaptive, randomized, double-blind, placebo-controlled study that enrolled hospitalized patients with HFpEF admitted to 12 centers in Japan. Patients who had left ventricular ejection fraction ≥50% and TAPSE/PASP <0.57 mm/mmHg at discharge were randomized 1 : 1 to receive pimobendan 1.25 mg b.i.d. or placebo. The primary objective was to evaluate changes from baseline (day 0) to day 30 in exercise capacity measured by the 6-minute walking test. Enrollment was terminated due to the invalid result of the planned interim analysis. The median age of participants was 82 years and 46% were women. Pimobendan (n=24) or placebo (n=26) was administrated orally. At day 30, mean changes in 6-minute walking distance in patients who received pimobendan (+26.9 m 95% confidence interval; −2.0, +55.8) or placebo (+21.4 m 95% confidence interval; −14.3, +57.2) were not significantly different (P=0.402). Conclusions: Among patients with HFpEF and RV-PA uncoupling, administration of pimobendan for 30 days did not result in significant improvement in exercise capacity compared with placebo.
Nakagawa et al. (Wed,) conducted a rct in Heart failure with preserved ejection fraction and right ventricular-pulmonary arterial uncoupling (n=50). Pimobendan vs. Placebo was evaluated on Change in 6-minute walking distance from baseline to day 30 (MD 5.5, 95% CI -38.9 to 49.8, p=0.402). Pimobendan did not significantly improve 6-minute walking distance compared to placebo in patients with heart failure with preserved ejection fraction and right ventricular-pulmonary arterial uncoupling (MD 5.5 m, p=0.402).